Author(s): Sreelakshmi Vangali1, Sridevi Boddu2, Seshaphani Udayagiri3, Madusudhan Reddy Katha4, Malleswari Rachamalla5, Nagaraju Thalikota6
Epidural anaesthesia with bupivacaine results in complete anaesthetic block of longer duration than ropivacaine. Fentanyl as an adjuvant may improve the quality of block of ropivacaine while maintaining its advantage of early motor recovery. In this study, we propose to compare the efficacy of epidural Ropivacaine-Fentanyl (RF) with Bupivacaine-Fentanyl (BF) for lower abdominal and lower extremity surgeries.
MATERIALS AND METHODS
60 patients were randomly allocated to receive either epidural 0.5% ropivacaine 20 mL plus 50 mcg fentanyl (group RF) or 0.5% bupivacaine 20 mL plus 50 mcg fentanyl (group BF). The onset, duration, spread of sensory and motor block, intensity of motor block, duration of analgesia, haemodynamic parameters and side effects were recorded. Statistical package for social sciences v20 software was used for statistical analysis.
The mean onset of sensory block to T10 dermatome was faster in group BF (8.6 ± 2.3 mins.) compared to group RF (11.5 ± 3.4 mins.). The time taken for maximum cephalad spread or time taken to reach highest sensory level and complete motor block was faster in group BF than group RF. Duration of analgesia (time for rescue analgesia) was comparable in both the groups (RF - 279.3 ± 37.3 mins. and BF - 288.5 ± 40 mins., not statistically significant). Two segment regression of sensory block was 151.7 ± 23.2 mins. in group RF and 142.8 ± 28.7 mins. in group BF, which is not statistically significant. The onset of grade I motor block was faster in group BF (8.43 ± 1.81 mins.) than group RF (14.03 ± 5.02 mins.). The mean duration of motor block was shorter in group RF 100.2 ± 26.9 mins. than group BF 147 ± 26.3 mins. The intensity of motor block achieved was more in group BF than group RF. The haemodynamic stability was better in group RF than group BF.
Epidural ropivacaine with fentanyl provided satisfactory block with better haemodynamic stability for major lower abdominal and lower extremity surgeries. It provided similar sensory block, but with a slower onset and motor block of slower onset, less intensity and shorter duration compared to bupivacaine with fentanyl, which is a desirable feature for early ambulation and shorter hospital stay.